European Journal of Radiology

Editorial Board

2012-06-01

Is celiac artery compression syndrome genetically inherited?: A case series from a family and review of the literature

Rıza S. Okten, Fahrettin Kucukay, Muharrem Tola, Birol Bostanci, Turhan Cumhur — 2012-06-01

Abstract: The median arcuate ligament is a tendinous arch joining the two medial borders of the diaphragm crura together. In 13–50% of asymptomatic subjects it is responsible for significant angiographic celiac trunk compression. The significance of median arcuate ligament-associated celiac artery compression has been a source of some controversy in the past literature, and the etiology remains unclear. We report here a case series from a family that was diagnosed by the use of multidetector computed tomography. The observation of this syndrome in a family suggests that the responsible anatomic relationships are congenital and may be genetically inherited.

CT diagnosis of intrasplenic metastasis from ovarian carcinoma

Senem Senturk, Musturay Karcaaltıncaba, Deniz Akata — 2012-06-01

Abstract: Intrasplenic metastases from ovarian carcinoma cannot be always demonstrated intraoperatively. CT is the most important imaging modality of choice for staging and follow-up ovarian cancer; in this study we searched CT appearances of intrasplenic metastases from ovarian carcinoma. We retrospectively reviewed imaging histories of the patients with ovarian cancer from the radiology information system, and found 12 patients with intrasplenic metastasis. All patients underwent abdominal CT with 16-MDCT. We searched number, density and maximum diameters of splenic metastasis. The growing rate of three lesions, which were followed up by CT, was calculated. Serum cancer antigen (CA) 125 levels were noted. We also evaluated clinical history and pathology reports of all patients.Splenic metastases, solitary or multiple, were detected most frequently during the follow-up (1–14 years after initial diagnosis) and most were associated with other sites of recurrence. The diameters of lesions ranged from 4 to 85mm. All lesions appeared hypodense except for one lesion with dense calcification. Densities of lesions ranged from 12 to 208 Hounsfield units (mean, 49±51HU). Most lesions appeared as solid well-defined nodules; however some lesions had lobulated and irregular contours with an infiltrative pattern. The growing rates of three lesions were 0.72mm/month, 1.75mm/month and 2.70mm/month. Eight patients had elevated serum CA 125 levels (40–1256U/mL).We concluded that CT can demonstrate intraparenchymal and infiltrative splenic metastasis in patients with ovarian cancer even in the absence of increased CA 125 levels.

Quantitative analysis of liver function using superparamagnetic iron oxide- and Gd-EOB-DTPA-enhanced MRI: Comparison with Technetium-99m galactosyl serum albumin scintigraphy

2012-06-01

Abstract: Purpose: To examine whether or not the parameters regarding the signal intensity of the liver parenchyma on superparamagnetic iron oxide (SPIO)- and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI are correlated with the parameters of Technetium-99m galactosyl serum albumin (99mTc-GSA) scintigraphy.Materials and methods: This retrospective study consisted of 55 and 33 patients who underwent SPIO- and Gd-EOB-DTPA-enhanced MRI in addition to 99mTc-GSA scintigraphy, respectively. For each patient, we calculated Pre R2* and Pre R2, which are equivalent to R2* (=1/T2*) and R2 (=1/T2) values of the liver parenchyma; ΔR2* and ΔR2, which represent differences in R2* and R2 values of the liver parenchyma before and after administration of SPIO; and the increase rates of both the liver-to-spleen signal intensity ratio (LSR) and the liver-to-major psoas muscle signal intensity ratio (LMR) on the hepatobiliary phase compared with the precontrast image. For 99mTc-GSA scintigraphy, the receptor index LHL15 and the blood clearance index HH15 were recorded.Results: Regression analysis showed a moderate correlation between Pre R2* and LHL15 (P<0.05). Mild to moderate correlations were also obtained between any combination of ΔR2* and ΔR2 on the one hand, and LHL15 and HH15 on the other (P<0.05). There were moderate correlations between any combination of increase rates of LSR and LMR on the one hand, and LHL15 and HH15 on the other (P<0.05–0.001).Conclusion: Pre R2*, ΔR2*, ΔR2 and the increase rates of LSR and LMR could be used as quantitative indicators of liver function.

Comparison between a clinical activity index (Harvey–Bradshaw-Index), laboratory inflammation markers and quantitative assessment of bowel wall vascularization by contrast-enhanced ultrasound in Crohn's disease

C. Girlich, D. Schacherer, E.M. Jung, A. Schreyer, R. Büttner — 2012-06-01

Abstract: Purpose: Due to its character as a remitting inflammatory disease, patients suffering from Crohn's disease (CD) often undergo several imaging studies subjecting the mostly young patients to ionizing. Contrast enhanced ultrasound for capillary microvascular assessment might be a new diagnostic tool for identifying the activity of inflammation by ultrasound techniques.Materials and methods: We prospectively evaluated 45 patients with proven Crohn's disease performing contrast enhanced ultrasound (CEUS) and laboratory assessment including C-reactive protein (CRP), leucocytes and hematocrit as well as calculating the Harvey–Bradshaw Index (HBI). Thereafter, we applied the quantification software Qontrast® to obtain contrast-enhanced sonographic perfusion maps.Results: Analysis of the 41 finally included patients revealed a correlation of CRP to HBI and TTP[s], respectively. Moreover, an association was found for HBI and TTP[s] and for HBI and TTP[s]/Peak [%]. Analysis of 34 patients with a Peak [%] ≥25 showed a close association of HBI and CRP. Besides, in these patients CRP correlated to TTP[s] and to TTP[s]/Peak [%]. We found a strong negative correlation between HBI and TTP[s] (r=−0.645, p<0.01), thus, the higher the clinical activity the shorter the time-to-peak.Conclusion: Quantitative evaluation with CEUS, particularly the calculation of TTP[s] in patients with a Peak [%] ≥25, provides a simple method to assess the inflammatory activity in CD.

Hepatic artery stenosis in liver transplantation: Imaging and interventional treatment

2012-06-01

Abstract: Introduction: Main purpose of our study is to demonstrate the spectral and color Doppler ultrasonography (DUS) findings that would indicate hepatic artery stenosis (HAS) after liver transplantation and to report our single center results. Moreover we want to establish role and limits of the different imaging techniques in detecting HAS, proposing a non invasive diagnostic approach and to depict indications and feasibility of endovascular treatment in the single patient.Materials and methods: Our study consisted of 222 patients who underwent liver transplantation between January 1999 and December 2009. DUS findings were correlated with multidetector computed tomography angiography (MDCTA) and angiographic results.Results: HAS occurred in 21 cases (9.5%). In all cases diagnosis was performed by DUS. MDCTA quantified stenosis and showed an overall picture of splanchnic vascularization. Based on DUS and MDCTA data integration, in 9 cases we adopted the “wait and see” strategy. Moreover in 12 cases treatment was considered necessary. For hepatic artery stenosis, use of DUS criteria resulted in a sensitivity of 100% (20/20), a specificity of 99.5% (201/202), a positive predictive value (PPV) of 95% (20/21), and negative predictive value (NPV) of 100% (201/201), and an overall accuracy of 99.5% (221/222).Conclusion: Our study underline the role of DUS in early diagnosis of HAS: repeated evaluation of both direct and indirect signs increases NPV and sensitivity of DUS.

Enhancement pattern analysis of hypervascular hepatocellular carcinoma on dynamic MR imaging with histopathological correlation: Validity of portal phase imaging for predicting tumor grade

2012-06-01

Abstract: Purpose: To elucidate the correlation between hypervascular hepatocellular carcinoma (HCC) enhancement patterns on dynamic MR imaging and histological findings.Materials and methods: Surgically proven 46 hypervascular HCCs of forty-one patients were enrolled. For each HCC, the signal intensity in the portal phase (SIPP) was evaluated. In this study, high, iso-, or low intensity in the portal phase was hypothesized as late, moderate, or early washout pattern, respectively. The SIPP of each HCC was correlated to histological grade and architectural subtypes that represent degrees of trabecular structure. For the trabecular HCCs, the thickness of tumor plate was also correlated for indirect estimation of tumor sinusoid.Results: There was a significant correlation between the SIPP vs. histological grade and also vs. architectural subtypes, namely the degree of trabecular structure. Washout of hypervascular HCC occurred earlier as the histological grade advanced and the histological architecture got closer to pure trabecular HCC. For the trabecular HCCs, the thickness of tumor plate correlated significantly with SIPP or histological grade. Hypervascular HCCs with thicker tumor plates showed worse histological grade and earlier washout pattern.Conclusions: Histological grade of hypervascular HCC may be predicted using SIPP. The thickness of tumor plate, resultantly the size of sinusoid between tumor plates, can account for the relationship between washout pattern and histological grade in the trabecular HCCs.

Accurate fat fraction quantification by multiecho gradient-recalled-echo magnetic resonance at 1.5T in rats with nonalcoholic fatty liver disease

2012-06-01

Abstract: Aim: To assess the diagnostic accuracy of a new reconstruction technique for gradient-recalled-echo magnetic resonance (MR) sequences that provides a full decomposition of the water and fat content inside a voxel for nonalcoholic fatty liver disease (NAFLD) in rats.Material and methods: Rats were randomized into two groups. A control group (n=10) was given free access to regular dry rat chow for 4 weeks. The steatosis (n=40) group was given free access to feed and water 4 days per week, and fasted for the remaining 3 days for 4 weeks. All rats were killed at 4 weeks and assessed for fatty infiltration and biochemical method.Results: The average fat content using the gold standard method was 2.65g (2.20–3.05) of fat/100g liver for the control group and 4.14g (1.95–8.60) of fat/100g of liver for the overfed group (p<0.05). The average fat-fraction obtained from the MR was 0.016 (0.01–0.02) for the control group and 0.057 (0.00–0.18) for the overfed group. The Pearson correlation coefficient between the samples was r2=0.87.Conclusion: Multi-echo MR is a good technique to quantify liver fat in rats.

Feasibility of using automated insufflated carbon dioxide (CO2) for luminal distension in 3.0T MR colonography

2012-06-01

Abstract: Purpose: Primary aim of our study was to prospectively evaluate the feasibility of automated carbon dioxide (CO2) delivery as luminal distending agent in 3.0T MR colonography.Materials and methods: Rectally insufflated CO2 was evaluated in four groups with different bowel preparation (A–D). Bowel preparation regimes were: gadolinium-based tagging (A), bowel purgation (B), barium-based tagging (C) and iodine-based tagging (D). Supine (3D)T1w-FFE and (2D)T2w-SSFSE series were acquired. Each colon was divided into six segments (cecum S1–rectum S6). Two observers independently assessed the presence of artefacts, diagnostic confidence and segmental colonic distension. Also characteristics of the residual stool (presence, composition and signal-intensity) were assessed per segment. Discomfort was assessed with questionnaires.Results: Fourteen healthy subjects were included. Colonic distension by means of rectally insufflated CO2 was not associated with susceptibility artefacts. Overall image quality was affected by the presence of bowel motion-related artefacts: none of the segments in 3DT1w-series and 10/84 (12%) colon segments in 2DT2w-series were rated artefact-free by both observers. Diagnostic confidence ratings were superior for the 2DT2w-SSFSE series. Overall bowel distension was rated adequate to optimal in 312/336 (93%) colon segments.Conclusion: MR colonography at 3.0T using carbon dioxide (CO2) for colonic distension is technically feasible. The presence of intraluminal CO2 did not result in susceptibility artefacts, although overall image quality was influenced by artefacts.

Usefulness of contrast-enhanced three-dimensional MR angiography using time-resolved imaging of contrast kinetics applied to description of Extracranial Arteriovenous Malformations: Initial Experience

2012-06-01

Abstract: Purpose: The purpose of this study was to evaluate the usefulness of contrast-enhanced three-dimensional MR angiography using time-resolved imaging of contrast kinetics (TRICKS-MRA) to demonstrate extracranial arteriovenous malformations (E-AVMs).Materials and methods: TRICKS-MRA was performed in 33 patients (adults; n=30, children; n=3) with E-AVMs. Four different scan protocols were arranged based on the size of E-AVM, and serial images were acquired from the start of contrast injection with a time frame ranging from 1.2 to 7.1s. Demonstration of feeding arteries and drainage veins, and the extent of nidus was qualitatively graded using a three-point scale. In sixteen patients who underwent DSA 3 days to 15 months after TRICKS-MRA, the comparability of TRICKS-MRA to DSA was evaluated using a three-point scale. In each category, score of 3 or excellent was defined as the positive result.Results: Demonstration of the feeding arteries, the drainage veins, and the extent of nidus were graded as excellent in 68%, 65%, and 58% of the patients, respectively. Comparability of TRICKS-MRA to DSA was excellent in 75%, 88%, and 88% of the sixteen patients who underwent DSA.Conclusion: TRICKS-MRA is a feasible and useful vascular imaging technique to provide time-resolved analysis of angioarchitecture of E-AVMs.

Radiation dose of digital tomosynthesis for sinonasal examination: Comparison with multi-detector CT

2012-06-01

Abstract: Objective: Using an anthropomorphic phantom, we have investigated the feasibility of digital tomosynthesis (DT) of flat-panel detector (FPD) radiography to reduce radiation dose for sinonasal examination compared to multi-detector computed tomography (MDCT).Materials and methods: A female Rando phantom was scanned covering frontal to maxillary sinus using the clinically routine protocol by both 64-detector CT (120kV, 200mAs, and 1.375-pitch) and DT radiography (80kV, 1.0mAs per projection, 60 projections, 40° sweep, and posterior–anterior projections). Glass dosimeters were used to measure the radiation dose to internal organs including the thyroid gland, brain, submandibular gland, and the surface dose at various sites including the eyes during those scans. We compared the radiation dose to those anatomies between both modalities.Results: In DT radiography, the doses of the thyroid gland, brain, submandibular gland, skin, and eyes were 230±90μGy, 1770±560μGy, 1400±80μGy, 1160±2100μGy, and 112±6μGy, respectively. These doses were reduced to approximately 1/5, 1/8, 1/12, 1/17, and 1/290 of the respective MDCT dose.Conclusion: For sinonasal examinations, DT radiography enables dramatic reduction in radiation exposure and dose to the head and neck region, particularly to the lens of the eye.

Magnetic resonance imaging features of nasopharyngeal carcinoma and nasopharyngeal non-Hodgkin's lymphoma: Are there differences?

2012-06-01

Abstract: Purpose: To describe differences in the primary tumour and distribution of cervical lymphadenopathy for cases of nasopharyngeal carcinoma (NPC) and nasopharyngeal non-Hodgkin's lymphoma (NPNHL) using magnetic resonance (MR) imaging.Materials and methods: MR images of patients with NPC (n=272) and NPNHL (n=118) were independently reviewed by two experienced radiologists.Results: NPC had a higher incidence of tumour invasion associated with the levator and tensor muscles of the velum palatine, the longus colli and medial pterygoid muscles, the base of the pterygoid process, the clivus, the base and greater wing of the sphenoid bone, the petrous apex, the foramen lacerum, the foramen ovale, the hypoglossal canal, and intracranial infiltration. In contrast, NPNHL had a higher incidence of tumour invasion associated with the hypopharynx, the palatine and lingual tonsils, as well as the ethmoid and maxillary sinuses. NPNHL also had a higher incidence of extensive and irregular bilateral lymphadenopathy, and lymphadenopathy in the parotid.Conclusions: NPC more often involved an unsymmetrical tumour with a propensity to invade both widely and deeply into muscle tissue, the fat space, the neural foramen, and the skull base bone. In contrast, NPNHL tended to be a symmetrical and diffuse tumour with a propensity to spread laterally through the fat space and along the mucosa to the tonsils of the oropharynx and hypopharynx. These differences facilitate a differentiation of these diseases using MR images, and enhance our understanding of the biological behavior of these malignant tumours of the nasopharynx.

The run-off resistance (ROR) assessed on MR angiograms may serve as a valid scoring system in patients with symptomatic peripheral arterial disease (PAD) and correlates with the ankle-brachial pressure index (ABI)

O. Gorny, W. Santner, G. Fraedrich, W. Jaschke, A. Greiner, M.F. Schocke — 2012-06-01

Abstract: Objective: To investigate the correlation between the hemodynamic parameter ankle-brachial pressure index (ABI) and the run-off resistance (ROR) assessed on MR angiograms (MRA) in patients with peripheral arterial disease (PAD) Fontaine Stage I and II and its potential as reliable reporting system in clinical routine.Methods: Contrast-enhanced MRA was performed in 321 PAD patients using a 1.5T MR scanner with moving bed technique. The ROR and resting ABI were determined in each patient's leg and correlation analysis was performed using the Pearson test.Results: A significant negative correlation (r=−.513; p<.001) between ROR (mean 11.03±5.42) and resting ABI (mean .81±.26) was identified. An even more pronounced correlation was found in patients younger than median age who had higher ABI values (r=−.608; p<.001).Conclusion: The ROR scoring system evaluated in this series correlates better with the ABI than previously published scoring systems and could be suggested as reporting system for routine MRA evaluation.

Comparative study of predilation with stent filter for Budd-Chiari syndrome with old IVC thrombosis: A nonrandomized prospective trial

Yan-Li Wang, Peng-Xu Ding, Yong-Dong Li, Xin-Wei Han, Gang Wu — 2012-06-01

Abstract: Purpose: To evaluate whether predilation approach yield intermediate-term results were better than those with stent filter approach.Materials and methods: 59 BCS patients with old IVC thrombosis were selected for the treatment with a stent filter (n=33, group A) or predilation (n=26, group B) before thrombolysis, and subsequently underwent color Doppler ultrasound follow-up at our hospital. Data relating to the technical success, color Doppler ultrasound results, cost, mortality, morbidity, and final clinical results were collected prospectively and follow-ups were performed 1, 3, 6, and 12 months after the procedures, and annually thereafter.Results: Sent filter placement, thrombolysis and predilation were technically successful in all patients, with no procedure-related complications. Stent migration upward occurred in two patients, and removal of the stent filter was technically successful in 32 of 33 patients in group A. Inferior vena cavagrams performed before dilation with a 30-mm balloon catheter demonstrated that the IVC thrombus had completely resolved in all patients without pulmonary embolism. Reobstruction of the IVC without thrombosis was observed in three patients. Short of higher overall complications and costs in group A when compared to group B, there were no other differences in the clinical and color Doppler ultrasound findings, and primary patency rate between the two groups. All patients are alive with no recurrence of thrombosis at the time of this report.Conclusions: BCS patients with old IVC thrombosis treatment with predilation approach yielded intermediate-term results that were better than those with the stent filter approach.

Super-micro-bland particle embolization combined with RF-ablation: Angiographic, macroscopic and microscopic features in porcine kidneys

2012-06-01

Abstract: Purpose: To describe angiographic, macroscopic and microscopic features of super-micro-bland particle embolization in combination with RF-ablation in kidneys. Thereby, a special focus was given on the impact of the sequence of the different procedural steps.Materials and methods: In ten pigs, super-micro-bland particle embolization combined with RF-ablation was carried out. Super-micro-bland embolization was performed with spherical particles of very small size and tight calibration (40±10μm). In the left kidneys, RF-ablations were performed before embolization (I). In the right kidneys, RF-ablations were performed after embolization (II). The animals were killed three hours after the procedures. Angiographic (e.g. vessel architecture), macroscopic (e.g. long and short axes of the RF-ablations) and microscopic (e.g. particle distribution) study goals were defined.Results: Angiography detected almost no vessels in the center of the RF-ablations in I. In II, angiography could not define the RF-ablations. Macroscopy detected significantly larger long and short axes of the RF-ablations in II compared to I (52.2±3.2mm vs. 45.3±6.9mm [P<0.05] and 25.1±3.5mm vs. 20.0±1.9mm [P<0.01], respectively). Microscopy detected irregular particle distribution at the rim of the RF-ablations in I. In II, microscopy detected homogeneous particle distribution at the rim of the RF-ablations. Microscopy detected no particles in the center of the RF-ablations in I and II.Conclusion: The sequence of the different procedural steps of super-micro-bland particle embolization combined with RF-ablation impacts angiographic, macroscopic and microscopic features in kidneys in the acute setting.

Transarterial chemoembolization in very early and early-stage hepatocellular carcinoma patients excluded from curative treatment: A prospective cohort study

2012-06-01

Abstract: Aim: To assess clinical outcome of transarterial chemoembolization (TACE) in a series of patients with early-stage hepatocellular carcinoma (HCC), within Milan criteria, but clinically unfit for liver transplantation (OLT).Methods: From January 2006 to May 2009, 67 patients (43 males, mean age 70±7.6 years) with very early or early-stage unresectable HCC, within Milan selection criteria but clinically unfit for OLT, underwent TACE. The primary endpoint of the study was overall survival. Secondary endpoints were: safety, liver toxicity, 1-month tumour response according to the amended RECIST criteria, time to local and distant intrahepatic tumour recurrence and time to radiological progression.Results: Two major periprocedural complications occurred (3%), consisting of liver failure. Periprocedural mortality rate was 1.5% (1 patient). A significant increase in ALT and bilirubin levels 24h after treatment was reported, with progressive decrease at discharge. At 1-month follow-up, complete and partial tumour response rates were 67.2% and 29.8%, respectively, with two cases of progressive disease. Mean follow-up was 37.3±15 months. The 1-, 2-, and 3-year overall survival rates were 90.9%, 86.1%, and 80.5%, respectively. Median expected time to local tumour recurrence and intrahepatic tumour recurrence were 7.9 and 13.8 months, respectively. Radiological disease progression was observed in 12 patients (17.9%) with a mean expected time of 26.5 months.Conclusion: In patients with early-stage HCC, clinically excluded from OLT and unfit for surgery or percutaneous ablation, TACE is a safe and effective option, with favourable long-term survival.

Results of endovascular treatment for intracranial wide-necked saccular and dissecting aneurysms using the Enterprise stent: A single center experience

Xianli Lv, Youxiang Li, Yang Xinjian, Chuhan Jiang, Zhongxue Wu — 2012-06-01

Abstract: Objective: The aim of the present retrospective study is to compare outcome of the endovascular treatment using the Enterprise stent in intracranial wide-necked saccular and dissecting aneurysms.Methods: Forty-six patients with 50 complex intracranial aneurysms admitted between June 2009 and November 2010 were treated using Enterprise stents. Thirty-one aneurysms were wide-necked saccular, 19 aneurysms dissecting. In 48 cases, aneurysms were occluded by stent-assisted coiling; in 2 cases, by stent alone.Results: Among the aneurysms treated with the Enterprise stent, patient sex, aneurysm location, hypertension history and the immediate angiographic results differed significantly between the saccular and dissecting aneurysm groups. However, recurrence rate, clinical follow-up outcomes did not differ significantly between the saccular and dissecting groups. There was 1 (2%) procedure-related complication, which caused death in the saccular group. At mean 9.1-month follow-up, the result was good in all dissecting cases and good in 30 saccular cases. There was 1 recurrence in each group.Conclusions: Enterprise stent is very useful for endovascular embolization of intracranial wide-necked saccular and dissecting aneurysms because it is easy to navigate and place precisely. The overall morbidity and mortality rates were low.

CT-guided single high-dose percutaneous acetic acid injection for small hepatocellular carcinoma: A long-term follow-up study

Heng Ma, Jing Liu, Fengli Liu — 2012-06-01

Abstract: Objective: To evaluate the long-term outcome of CT-guided single high-dose percutaneous acetic acid injection (PAI) for the treatment of small hepatocellular carcinoma (SHCC).Materials and methods: Sixty-eight consecutive patients (37 men and 31 women; age 52±16 years) with SHCC have undergone CT-guided single high-dose PAI therapy since December 2000. Complications of high-dose PAI were recorded. Tumour survival and recurrence rates were assessed.Results: All PAI therapies were successful and no severe complications developed. The average follow-up period was 46±18 months. The overall survival rates at 1, 2, 3, 4 and 5 years were 93%, 82%, 68%, 59% and 51%, respectively. The cumulative local recurrence rates for the main tumour at 1, 2, 3, 4 and 5 years were 18%, 22%, 25%, 28% and 28%, respectively. The cumulative new tumour recurrence rates at 1, 2, 3, 4 and 5 years were 24%, 40%, 43%, 60% and 62%, respectively.Conclusion: CT-guided single high-dose PAI is safe and effective for the treatment of SHCC after long-term follow-up.

Follow-up of abdominal aortic aneurysm after endovascular aortic repair: Comparison of volumetric and diametric measurement

J.D. Hahne, C. Arndt, J. Herrmann, B. Schönnagel, G. Adam, C.R. Habermann — 2012-06-01

Abstract: Purpose: To determine the correlation of maximal diameter measurements with volumetric evaluation of size after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) using computed tomography angiography (CTA) and to survey its applicability for clinical follow-up.Materials and methods: 73 consecutive patients (2 females, 71 males; age 38–84 years; mean age, 69.1±8 years) with AAA were treated with percutaneous EVAR in a single institution. For follow-up, CTA was performed periodically after EVAR. Images were evaluated for maximal diameter in consensus by two experienced radiologists. Using OsirixTM, volumetric measurements were done by one radiologist, including the entire infrarenal abdominal aorta.Results: In 73 patients 220 CTA examinations were performed after EVAR with a mean follow-up of 17.3 months (range, 1.8–42.7 months). The mean postinterventional volume of aneurysm was 165.63ml±93.29ml (range, 47.94–565.67ml). The mean maximal postinterventional diameter was 5.91±1.52cm (range, 3.72–13.82cm). At large over the entire observation period a slight, non-significant decrease of 1.6% (2.58ml±69.05ml, range 82.82–201.92ml) in volumes and a 9.3% (mean 0.55cm±1.22cm, range 2.85–1.93cm) in diameters were observed. For all examinations a high correlation of volume and diameter was calculated (r=0.813–0.905; α<0.01).Conclusion: For follow-up of abdominal EVAR using CTA there is a high correlation between volumetric and diametric measurements of aneurysm. Based on a daily clinical routine setting, measurements of maximal diameters in cross sectional imaging of AAA after EVAR seems to be sufficient to exclude post interventional enlargement.

Partial thyroid arterial embolization for the treatment of hyperthyroidism

2012-06-01

Abstract: Background: Hyperactive thyroid gland in patients that are unable to tolerate or accept standard therapy is a common clinical problem. Aim of the study was to evaluate effectiveness of partial thyroid arterial embolization in patients with hyperthyroidism.Material/methods: From May 2004 to November 2005 partial thyroid gland embolization was performed in 15 patients. Mean thyroid gland volume was 162ml. Embolization of one to three thyriod arteries was performed with the mixture of Histoacryl and Lipiodol. Selective angiography was performed after embolization to ensure that the targeted arteries were completely occluded. Follow-up study covered 12 patients.Results: The embolization procedure was well tolerated by all patients. Three days after embolization fT3 and fT4 levels were higher than before the procedure. Further laboratory tests showed quick reversal to near-normal or normal levels of thyroid hormones. 12 weeks follow-up showed: normal serum levels of fT3, fT4 and TSH in 9 of 12 patients (75%), hyperthyroidism in 3 of 12 patients (25%), goiter volume reduction of approximately 32% of its original volume (from 13 to 76.3%), mean thyroid gland volume of 94ml. One year after embolization 7 of 12 patients required thyreostatic drugs. At two and four years follow-up thyreostatics doses were significantly lower and thyroid tissue was fibrotic.Conclusions: Based on our results the treatment of the thyroid gland goiters using arterial thyroid gland partial embolization may be offered as an effective alternative for patients who will not or cannot accept standard therapy.

Catheter-directed thrombolysis of proximal lower extremity deep vein thrombosis: A prospective trial with venographic and clinical follow-up

Hannu Manninen, Auni Juutilainen, Erkki Kaukanen, Seppo Lehto — 2012-06-01

Abstract: Purpose: To prospectively evaluate the primary and long-term venographic and clinical results of catheter-directed thrombolysis in the treatment of proximal deep vein thrombosis (DVT) of lower extremity.Materials and methods: Fifty-six patients with mean age of 48 (range 15–81) years with acute DVT (symptom duration of less than 2 weeks), extending to high femoral (16 patients) or iliac vein (40 patients) were treated with selective catheter-directed thrombolysis. The mean total dose of 3.8 (range 1.0–8.1) million units of urokinase was administered during a mean of 39 (range 6–72) hours. Endovascular stenting was performed in 9 of the iliac DVT patients.Results: Complete procedural venographic success was achieved in 79% of patients. Major complications were noted in 7% of patients and the total rate of complications was 13%. Mean venographic follow-up was 3.5 years (range 3 months to 9.6 years); well preserved femoral vein valves and fully recanalized deep crural veins were observed in 83% and 57% of patients. Normal clinical findings in the affected limb were noted during the latest follow-up visit in 67% of patients. Clinical post-thrombotic syndrome occurred in 9% of patients.Conclusion: Catheter-directed thrombolysis achieves good primary success with acceptable complication rate and effectively reduces prevalence of post-thrombotic syndrome.

Complete ten-year follow-up after endovascular abdominal aortic aneurysm repair: Survival and causes of death

2012-06-01

Abstract: Purpose: To analyze the hazard and causes of death after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms during a complete ten year follow-up.Methods: This is a retrospective clinical study of 130 consecutive patients undergoing EVAR between 1995 and 1998. One-hundred twenty-one patients (93.1%) were treated with first-generation stentgrafts and nine patients (6.9%) received second-generation devices. All patients completed a follow-up of at least 10 years, unless death occurred before then. Time and causes of death were provided by the Austrian central register of deaths.Results: The median follow-up was 7.6 years, and the 130 patients had 968.5 person-years of follow-up. The ten-year mortality rate was 62.3%. Cardiovascular events were the most frequent causes of death, with a 3.9 incidence rate per 100 person-years. Cancer death and death due to other causes occurred in 2.1 and 1.8 cases per 100 person-years, respectively. Lethal late aneurysm rupture happened in 4.6% (n=6), which corresponds to an annual incidence rate of 0.6 per 100 person-years. All of those patients had been treated with first-generation devices.Conclusions: Cardiovascular events were the most frequent cause of death after EVAR, followed by malignancy and other diseases. The risk of dying from secondary rupture was clearly lower than that of death due to other reasons during ten years after EVAR, even in patients with first-generation stentgrafts.

Ultrasound demonstration of distal triceps tendon tears

2012-06-01

Abstract: Purpose: Rupture of the distal triceps tendon is an uncommon injury that may be unrecognized on clinical examination. The purpose of the study is to describe the role of US in distal triceps tendon tears evaluation.Materials and methods: IRB approval was obtained and patients gave written informed consent. Of 77 consecutive US examinations of the elbow obtained over a five-year period, eight patients with correlative MR and surgery available were identified having partial or complete distal triceps tendon tear.Results: N=4 complete tears of the triceps tendon and n=4 partial tears of the distal triceps involving the lateral/superficial head were identified. Patients with partial tear had a history of a single traumatic event that determined a sudden eccentric contraction of the triceps muscle against resistance. US demonstrated on axial and longitudinal planes a partial tear of the triceps brachii tendon that resulted in a fusiform swelling and retraction of the lateral/superficial head in four patients. It was possible to identify the normal insertion of the medial head of the triceps moving the transducer medially. MR and surgical findings were concordant with US findings in every patient.Conclusion: Ultrasound is able to differentiate complete from partial triceps tendon tears. US has the potential to identify isolated lesions of the lateral/superficial head of the triceps with an intact medial head.

The avascular plane of the Achilles tendon: A quantitative anatomic and angiographic approach and a base for a possible new treatment option after rupture

2012-06-01

Abstract: Introduction: Achilles tendon ruptures, especially ruptures caused by pathologic conditions and also by achillotendinitis are often attributed to the alleged hypovascularisation of the Achilles tendon. Anatomic studies often mention an avascular plane. The purpose of this study was to re-investigate the arterial supply of the Achilles tendon.Material and methods: Lower legs of 28 anatomic specimen were injected with a radiologic contrast agent and subsequently an arterial angiography was performed. Afterwards the legs were embalmed and later anatomically dissected. The origin of arteries entering the paratenon of the tendo calcanei branching off from either the anterior (TA) or the posterior tibial artery (TP) was determined. The distance between the points of commencement of these nutrient arteries and a specific reference point, i.e. the insertion of the Achilles tendon into the tuber calcanei, was measured digitally on the radiographs and again with a slide-gauge on the dissected specimens.Results: As revealed by angiographic analysis, the TA gave off 5 vessels (v) at a frequency and median distance to the tuber calcanei (in cm) of v1: 50%, 6.01cm; v2: 39.3%, 7.88cm; v3: 35.7%, 9.71cm; v4: 17.9%, 12.7cm; v5: 10.7%, 14.6cm. The TP contributed to the arterial supply of the Achilles tendon by means of 7 inserting arteries branching off at a frequency and mean distances of v1: 67.9%, 4.53cm; v2: 60.7%, 6.97cm, v3: 50%, 9.58cm; v4: 35.7%, 10.89cm; v5: 25%, 12.65cm; v6: 10.7%, 16.94cm; v7: 3.6%, 18.7cm proximal to the tuber calcanei. However, due to the small diameter of these branches, by anatomic dissection no nutrient arteries commencing from the TA could be detected. On the other hand, a maximum of 7 vessels originating from the TP, larger than the former vessels, had been also revealed by anatomic dissection (frequency and mean distances, v1: 100%, 6.8cm; v2: 82.1%, 7.7cm; v3: 71.4%, 9.5cm; v4: 35.7%, 11.3cm; v5: 17.9%, 9.9cm; v6: 7.1, 10.5cm; v7: 3.6%, 12.0cm).Conclusion: A dense net of small arteries inserts into the paratenon of the Achilles tendon in its lower 20cm. The angiographic method was more specific and showed vessels that could not be identified as arteries originating from the TA by macroscopic anatomic dissection.

Assessment of cartilage repair after chondrocyte transplantation with a fibrin-hyaluronan matrix – Correlation of morphological MRI, biochemical T2 mapping and clinical outcome

2012-06-01

Abstract: Objective: To evaluate change over time of clinical scores, morphological MRI of cartilage appearance and quantitative T2 values after implantation with BioCart™II, a second generation matrix-assisted implantation system.Methods: Thirty-one patients were recruited 6–49 months post surgery for cartilage defect in the femoral condyle. Subjects underwent MRI (morphological and T2-mapping sequences) and completed the International Knee Documentation Committee (IKDC) questionnaire. MRI scans were scored using the MR Observation of Cartilage Repair Tissue (MOCART) system and cartilage T2-mapping values were registered.Analysis included correlation of IKDC scores, MOCART and T2 evaluation with each other, with implant age and with previous surgical intervention history.Results: IKDC score significantly correlated with MOCART score (r=−0.39, p=0.031), inversely correlated with previous interventions (r=−0.39, p=0.034) and was significantly higher in patients with longer follow-up time (p=0.0028).MOCART score was slight, but not significantly higher in patients with longer term implants (p=0.199).T2 values were significantly lower in patients with longer duration implants (p<0.001). This trend was repeated in patients with previous interventions, although to a lesser extent.Conclusions: Significant improvement with time from BioCart™II implantation can be expected by IKDC scoring and MRI T2-mapping values. Patients with previous knee operations can also benefit from this procedure.

Quantitative perfusion computed tomography measurements of cerebral hemodynamics: Correlation with digital subtraction angiography identified primary and secondary cerebral collaterals in internal carotid artery occlusive disease

2012-06-01

Abstract: Background: The aim of the present study was to assess hemodynamic variations in symptomatic unilateral internal carotid artery occlusion (ICAO) patients with primary collateral flow via circle of Willis or secondary collateral flow via ophthalmic artery and/or leptomeningeal collaterals.Methods: Thirty-eight patients with a symptomatic unilateral ICAO were enrolled in the study. Based on digital subtraction angiography (DSA) findings, patients were classified into 2 groups: primary collateral (n=14) and secondary collateral (n=24) groups. Collateral flow hemodynamics were investigated with perfusion computed tomography (PCT) by measuring the cerebral blood flow (CBF), cerebral blood volume (CBV) and time to peak (TTP) in the hemispheres ipsilateral and contralateral to ICAO. Based on the measurements, the ipsilateral to contralateral ratio for each parameter was calculated and compared.Results: Irrespective of the collateral patterns, ipsilateral CBF was not significantly different from that of the contralateral hemisphere (P=0.285); ipsilateral CBV and TTP was significantly increased compared with those of the contralateral hemisphere (P=0.000 and P=0.000 for CBV and TTP, respectively). Furthermore, patients with secondary collaterals had significantly larger ipsilateral-to-contralateral ratios for both CBV (rCBV, P=0.0197) and TTP (rTTP, P=0.000) than those of patients with only primary collaterals. These two groups showed no difference in ipsilateral-to-contralateral ratio for CBF (rCBF, P=0.312).Conclusion: Patients with symptomatic unilateral ICAO in our study were in an autoregulatory vasodilatation status. Moreover, secondary collaterals in ICAO patients were correlated with ipsilateral CBV and delayed TTP that suggested severe hemodynamic impairment, presumably increasing the risk of ischemic events.

MR findings of Rosai–Dorfman disease in sellar and suprasellar region

Xin Lou, Zhi-ye Chen, Fu-lin Wang, Lin Ma — 2012-06-01

Abstract: Background: Rosai–Dorfman disease (RDD) in sellar/suprasellar region is a rare intracranial disorder. The diagnostic evaluation of this condition using magnetic resonance imaging (MRI) has seldom been described previously. The purpose of our study was to describe MRI characteristics of sellar/suprasellar region RDD.Methods: Five patients with proved sellar/suprasellar region RDD from May 2005 to March 2010 were retrospectively reviewed. All the patients had undergone magnetic resonance scanning. The number, location, signal intensity (SI), and enhancement pattern of the lesions on MRI were retrospectively evaluated.Results: Pathological diagnosis of RDD was achieved in all 5 cases including 4 by surgery and 1 by biopsy. The most common presenting symptoms were headache (n=4) and blurred vision (n=3). On MRI, isolated suprasellar lesion was found in 2 cases. Suprasellar lesion combined with intrasellar, dural, intra-axial and orbital lesions was found in 3 cases. All lesions showed homogeneous isointense SI on T1-weighted images and hypointense to isointense SI on T2-weighted images except one lesion in the midbrain with slight hyperintense SI on T2-weighted images. All lesions showed homogeneous enhancement.Conclusion: Homogenously enhancing sellar/suprasellar masses of hypointense to isointense SI on T2-weighted images are suggestive of RDD, and central hypointensity on T2-weighted images may be a specific finding. Intra-axial and extra-axial involvements may coexist with sellar/suprasellar region RDD. Although radiological findings can provide some evidence for this rare entity, differential diagnosis is still needed.

Susceptibility-weighted angiography (SWAN) of cerebral veins and arteries compared to TOF-MRA

2012-06-01

Abstract: Problem: High resolution, non-contrast imaging of both cerebral veins and arteries by use of gradient echo T2 star weighted angiography (SWAN) is a new method for susceptibility-weighted imaging with short acquisition times. We assessed the potential of this sequence for the depiction of both cerebral veins and arteries.Methods: 15 healthy volunteers were included in the study. MRI was performed on a 3T MR scanner using the following sequences: (1) a 3D multi-echo gradient echo T2 star weighted angiography (SWAN), (2) an arterial 3D TOF MR angiography and (3) a venous 2D TOF.With regard to the SWAN sequence, both MinIP and MIP images were reconstructed and systematically compared to MIP reconstructions of the artTOF and the venTOF. To suggest possible clinical implications of our findings, we additionally included two illustrative cases.Results: With regard to the visualization of the cerebral veins, the MinIP reconstructions of the SWAN sequence were considerably superior compared to the venTOF. Concerning the depiction of the main segments of the big cerebral arteries the value of the MIP reconstructions of the SWAN was comparable to that of the artTOF with limitations in the homogenity and in the depiction of smaller arteries.Conclusions: SWAN allows for high-resolution visualization of both cerebral veins and arteries in one sequence without application of contrast agent and with significantly shortened scan time compared to the combined scan time of TOF-MRA and TOF-MRV. By use of either MinIP or MIP reconstructions, the arteries can be distinguished from the veins.

Perfusion Computed Tomography (PCT) adopting different perfusion metrics: Recurrence of brain metastasis or radiation necrosis?

2012-06-01

Abstract: Objective: Different perfusion metrics were investigated to determine the accuracy of Perfusion CT (PCT) in differentiating recurrence of brain metastases from radiation necrosis in patients who previously underwent stereotactic radiation therapy (SRT).Patients and Methods: Twenty patients previously treated with SRT underwent PCT examination of the brain. Normalized Cerebral Blood Volume (nCBV) values within the region of interest (ROI) were calculated. Fractional volumes at nCBV values between 1.0 and 2.25, defined as V1.0–V2.25, were derived as alternative metrics and compared to the conventional method based on the mean CBV value within the lesion (nCBVmean). The Mann–Whitney test was used to compare the two patient's groups with recurrence and radiation necrosis with respect to the different nCBV metrics. Predictive powers and optimal thresholds for both the nCBVmean and the V1.0–V2.25 were evaluated using the Receiver Operating Characteristic Curves. The gold standard was represented either by the histopathological examination or the Magnetic Resonance (MR) imaging follow-up longer than six months.Results and Conclusion: The differences between the patient's group with recurrence and that with radiation necrosis resulted statistically significant for all the metrics, showing the lowest p-value for V1.75 and V2. The metrics based on the fractional volumes were found to show higher predictive powers, with the highest value of 0.96 for V2.0. Quantitative analysis of the CBV map deriving different metrics may potentially improve the diagnostic accuracy of PCT in differentiating brain metastasis recurrence from radiation necrosis.

Imaging of spontaneous intracerebral hemorrhages by means of transcranial color-coded sonography

Beata Kukulska-Pawluczuk, Barbara Książkiewicz, Magdalena Nowaczewska — 2012-06-01

Abstract: Background: Transcranial color-coded sonography (TCCS) allows the visualization of cerebral structures and enables monitoring of circulatory disorders occurring within the circle of Willis.Objective: To verify whether TCCS is a reliable method in imaging intracerebral hemorrhages (ICHs) and to what degree its results are consistent with these by means of computed tomography (CT).Methods: This study included 39 patients with spontaneous ICHs of supratentorial and infratentorial locations. Initial TCCS was done not later than 12h after initial CT. Clinical findings and the measurements of hemorrhagic foci and midline shift (MLS) were compared between these two methods.Results: TCCS revealed ICHs in 34 patients, including 29 and 5 with supra- and infratentorial localization, respectively. Moreover, it showed 12 cases (35.3%) of intraventricular hemorrhage (IVH) and 16 cases of a midline shift (MLS). No significant differences were found between the measurements of hemorrhagic foci or MLS obtained by TCCS and CT. There was a significant correlation between the volumes of hemorrhagic foci or MLS values measured by both methods analyzed (R=0.99 or R=0.98, respectively). Additionally, MLS was shown to increase significantly with the volume of hemorrhagic foci (R=0.90).Conclusions: The high correlation between TCCS and CT in imaging spontaneous ICHs introduces the possibility of applying TCCS in everyday clinical practice.

Percutaneous discectomy on lumbar radiculopathy related to disk herniation: Why under CT guidance? An open study of 100 consecutive patients

2012-06-01

Abstract: The primary objective of this study conducted on 100 patients is to demonstrate that performing CT-guided percutaneous discectomy for herniated disks results in a significant improvement in pain symptoms at several times (D1, D2, D7, 1 month, 3 months, 6 months). This objective assesses the effectiveness and feasibility of this technique under CT guidance in patients presenting documented lower back pain related to disk herniation that has not improved with appropriate medical treatment. The impact of various factors on the effectiveness of discectomy will also be evaluated. At 1 week, we notes a decrease in average VAS respectively of 71% and 67% in patients treated for posterolateral and foraminal herniated disks; the result for posteromedian herniated disks is only 45% in average decrease. At 6 months post op, 79% of lateralized herniated disks have a satisfactory result (≥70% decrease in pain as compared to initial pain), whereas post median herniated disks had a satisfactory result in only 50% of cases. Percutaneous fine needle discectomy probe under combined CT and fluoroscopic guidance is a minimally invasive spine surgery which should be considered as an alternative to surgery. This technique presents several advantages: the small diameter of the probe used (maximum 16G or 1.5mm) allows a cutaneous incision of only a few millimeters, and a trans-canal approach can be possible; it also decreases the risk of ligamentary lesion and does not cause an osseous lesion of the posterior arc or of the adjacent muscular structures.

Imaging characteristics of Rosai-Dorfman disease in the central nervous system

2012-06-01

Abstract: Background and purpose: Rosai-Dorfman disease (RDD) is a rare, lymphoproliferative disorder of uncertain etiology. The Central Nervous System (CNS) is a very rare site for RDD and only a few imaging appearances have been described. The purpose of this study is to present the largest series of cases in the CNS imaging literature to increase familiarity with this entity and further identify features that may distinguish RDD from meningioma.Materials and methods: Findings from imaging examinations in 10 patients with pathologically confirmed RDD were retrospectively reviewed. Two radiologists evaluated the lesion location, shape, size, number, edge, cerebral edema, homogeneous or heterogeneous appearance, attenuation and signal intensity, degree of enhancement, and the relation between lesions and meninges.Results: RDD in CNS showed similar features in imaging: an extra-axial, well-circumscribed, dura-based mass, isodense or hyperdense on CT, isointensity on T1-weighted imaging and isointensity with hypointensity on T2-weighted imaging. The mass enhanced markedly and homogeneously after the administration of contrast agent and demonstrated dural tail sign in all cases. Significant perifocal edema was associated with the masses. Remarkably, seven patients (77.8%) showed strong hypointensity within isointensity on T2-weighted or FLAIR images and no calcification was observed in CT images or pathologic specimens.Conclusions: Although RDD in the CNS is a rare process, it should be considered in the differential diagnoses for meningioma. We believe that a typical representation of hypointensity irrelevant to calcification on T2-weighted or FLAIR images can suggest the diagnosis of RDD.

Improvement of auditory hallucinations and reduction of primary auditory area's activation following TMS

2012-06-01

Abstract: Background: In the present case study, improvement of auditory hallucinations following transcranial magnetic stimulation (TMS) therapy was investigated with respect to activation changes of the auditory cortices.Methods: Using functional magnetic resonance imaging (fMRI), activation of the auditory cortices was assessed prior to and after a 4-week TMS series of the left superior temporal gyrus in a schizophrenic patient with medication-resistant auditory hallucinations.Results: Hallucinations decreased slightly after the third and profoundly after the fourth week of TMS. Activation in the primary auditory area decreased, whereas activation in the operculum and insula remained stable.Conclusions: Combination of TMS and repetitive fMRI is promising to elucidate the physiological changes induced by TMS.

Tiny intracranial aneurysms: Endovascular treatment by coil embolisation or sole stent deployment

Jun Lu, Jia-chun Liu, Li-jun Wang, Peng Qi, Da-ming Wang — 2012-06-01

Abstract: Purpose: Tiny intracranial aneurysms pose a significant therapeutic challenge for interventional neuroradiologists. The authors report their preliminary results of endovascular treatment of these aneurysms.Methods: Between January 2002 and December 2009, 52 tiny intracranial aneurysms (defined as ≤3mm in maximum diameter) in 46 patients (22 men; mean age, 57.9years) were treated by endosaccular coil embolisation or sole stent deployment in the parent artery. Of 52 aneurysms, 29 had ruptured and 23 remained unruptured. The initial angiographic results, procedural complications, and clinical outcomes were assessed at discharge. Imaging follow-up was performed with cerebral angiography.Results: One aneurysm coiling procedure failed because of unsuccessful micro-catheterization. Forty-three aneurysms were successfully coil embolized, of which complete occlusion was obtained in 14, subtotal occlusion in 18 and incomplete occlusion in 11. The other 8 aneurysms were treated by sole stent deployment in the parent artery. Procedural complications (2 intraprocedural ruptures and 3 thromboembolic events) occurred in 5 (9.6%) of 52 aneurysms, resulting in permanent morbidity in only 1 (2.2%, 1/46) patient. No rebleeding occurred during clinical follow-up (mean duration, 46.7months). Of the 16 coiled aneurysms that receiving repetitive angiography, 6 initially completely and 3 subtotally occluded aneurysms remained unchanged, 4 initially subtotally and 3 incompletely occluded aneurysms progressed to total occlusion. Five sole stent deployed aneurysms received angiographic follow-up (mean duration, 10.0months), of which 3 remained unchanged, 1 became smaller and 1 progressed to total occlusion.Conclusion: Endovascular treatment of tiny intracranial aneurysms is technical feasible and relatively safe. Coil embolisation seems to be effective in preventing early recanalisation, whereas sole stenting technique needs further investigation to determine its effectiveness.

Clinical usefulness of the visibility of the transcerebral veins at 3T on T2*-weighted sequence in acute stroke patients

2012-06-01

Abstract: Objectives: The objective of this work was to investigate the clinical usefulness of the visibility of the transcerebral veins (VTV) in acute ischemic stroke patients at 3T.Methods: Sixty consecutive carotid artery territory stroke patients were included retrospectively. Two readers categorized the VTV on T2*-weighted sequence at 3T for each hemisphere, and asymmetry of this sign was assessed between each hemisphere by an asymmetry index (AI) using a three-item scale. The VTV and AI were correlated with clinical and radiological covariates. Particular interest was focused on patients for whom initial diffusion-weighted imaging alone was inconclusive.Results: VTV were detected in the stroke hemisphere in 58.3% (n=35) and in the contralateral side in 10% (n=6, p<0.0001). Asymmetry of the VTV between ischemic and contralateral hemispheres was present in 53.3% (n=32). Intracranial artery occlusion, final infarct volume and symptomatic hemorrhagic transformation were correlated with a higher AI at baseline (ρ=0.563, ρ=0.291, and ρ=0.285, p<0.05, respectively). Three hyperacute stroke patients with subtle DWI high signal intensity at admission demonstrated VTV.Conclusions: The pathological value of the VTV seems to reside in its asymmetry between hemispheres, as it was correlated with important clinical parameters. This study also suggests that the VTV could be a supportive finding in stroke diagnosis, especially when DWI is unreliable.

Abnormal amygdala connectivity in patients with primary insomnia: Evidence from resting state fMRI

2012-06-01

Abstract: Background: Neurobiological mechanisms underlying insomnia are poorly understood. Previous findings indicated that dysfunction of the emotional circuit might contribute to the neurobiological mechanisms underlying insomnia. The present study will test this hypothesis by examining alterations in functional connectivity of the amygdala in patients with primary insomnia (PI).Methods: Resting-state functional connectivity analysis was used to examine the temporal correlation between the amygdala and whole-brain regions in 10 medication-naive PI patients and 10 age- and sex-matched healthy controls. Additionally, the relationship between the abnormal functional connectivity and insomnia severity was investigated.Results: We found decreased functional connectivity mainly between the amygdala and insula, striatum and thalamus, and increased functional connectivity mainly between the amygdala and premotor cortex, sensorimotor cortex in PI patients as compared to healthy controls. The connectivity of the amygdala with the premotor cortex in PI patients showed significant positive correlation with the total score of the Pittsburgh Sleep Quality Index (PSQI).Conclusions: The decreased functional connectivity between the amygdala and insula, striatum, and thalamus suggests that dysfunction in the emotional circuit might contribute to the neurobiological mechanisms underlying PI. The increased functional connectivity of the amygdala with the premotor and sensorimotor cortex demonstrates a compensatory mechanism to overcome the negative effects of sleep deficits and maintain the psychomotor performances in PI patients.

Endovascular treatment of cerebral aneurysms associated with arteriovenous malformations

2012-06-01

Abstract: Background and purpose: In univariate survival analysis, coexisting aneurysms was associated with a significantly increased risk of hemorrhage in AVMs. We report here on our clinical experience with AVMs associated with arterial aneurysms that were managed by endovascular treatment.Methods: To determine the incidence of associated aneurysms, the authors reviewed 366 consecutive patients with AVMs managed between 1999 and 2009. In 86 (23.5%) of these 366 patients, 55 intranidal aneurysms and 40 proximal aneurysms were observed. Targeted endovascular treatment with coils, n-butylcyanoacrylate(NBCA) and Onyx was performed for patients in this series, using a standard protocol. We reviewed the treatment plans, radiological findings and clinical courses of 86 patients suffering AVM associated with aneurysm.Results: Ninety-five aneurysms in 86 patients with AVMs were enrolled in this study. Hemorrhage was the most frequent presenting symptom (69 patients, 80.2%). Bleeding was caused by an AVM nidus in 44 cases, aneurysm rupture in 20 and an undetermined origin in 5. Four patients were treated for associated aneurysm with coils followed by AVM embolization and 82 patients were treated with NBCA or Onyx embolization. There were total of 3 complications (3.5%) clinically significant complications in this series. Excellent or good outcomes (Glasgow Outcome Scale≥4) were observed in 63 (73.3%) patients at discharge. Neurological deficits (Glasgow Outcome Scale 1–4) were 16.6% at discharge.Conclusion: Endovascular treatment can be adequately used for cerebral aneurysms associated with AVMs as an adjunct to microsurgery and radiosurgery.

Voxel based morphometry of FLAIR MRI in children with intractable focal epilepsy: Implications for surgical intervention

Catherine J. Riney, William K. Chong, Chris A. Clark, J. Helen Cross — 2012-06-01

Abstract: Purpose: Magnetic resonance imaging (MRI), in particular fluid-attenuated inversion-recovery (FLAIR), has transformed the delineation of structural brain pathology associated with focal epilepsy. However, to date there is no literature on voxel based morphometry (VBM) of FLAIR in children with epilepsy. The aim of this study was to explore the role of visual and VBM assessment of FLAIR in pre-operative investigation of children with intractable focal epilepsy.Methods: Children with intractable epilepsy due to focal cortical dysplasia (FCD) and children with intractable cryptogenic focal epilepsy (CFE) were investigated. FLAIR and T1-weighted MRI were acquired on a 1.5T MRI scanner (Siemens, Erlangen, Germany). VBM was performed using SPM5 (Wellcome Institute of Cognitive Neuroscience, London).Results: Eight children with FCD (M=5, age 7.9–17.3 years) and 14 children with CFE (M=8, 7.8–16.8 years) were enrolled. VBM of FLAIR detected 7/8 (88%) of FCD whilst VBM of T1-weighted MRI detected only 3/8 (38%) FCD. VBM of FLAIR detected abnormality in 4/14 children with CFE, in 2/14 (14%) the abnormality was concordant with other data on the epileptogenic zone and with visible abnormality on repeat visual inspection of MR data. VBM of T1-weighed MRI detected abnormality in 2/14 children with CFE, none of which correlated with visible abnormality.Discussion: This study highlights the important role that FLAIR imaging has in the pre-operative assessment of children with intractable epilepsy. VBM of FLAIR may provide important information allowing selection of children with intractable CFE who are likely to benefit from further neuroradiological or neurophysiological evaluation.

MR imaging findings and MR criteria for instability in osteochondritis dissecans of the elbow in children

2012-06-01

Abstract: Purpose: Osteochondritis dissecans (OCD) of the elbow is an uncommon cause of elbow pain in adolescents and occurs at different locations in the elbow joint. Early diagnosis and treatment may prevent surgery. The aim of the study is to describe the MR imaging features of OCD at initial imaging, and to correlate these findings with surgical findings of stability and instability with arthroscopic findings as the reference standard.Methods: Patients were identified through a keyword search of the radiology information system from 2000 to 2009. Twenty-five patients (26 elbows) with OCD of the elbow were identified (age 10.4–18 years, mean age 14 years). MR studies were retrospectively reviewed by two radiologists in consensus to define MR imaging findings and to determine the presence of previously described MR imaging criteria for OCD instability (i.e., high T2 signal rim, surrounding cysts, high T2 signal fracture line, fluid-filled osteochondral defect). Sensitivity of the individual and combined criteria was calculated.Results: OCD occurred in the capitellum in 24 patients (92%), in the trochlea in 2 patients (8%) and radial head in 1 patient (4%). Loose bodies were identified in 11 (42%) patients. Eighteen patients demonstrated MRI findings in keeping with unstable lesions. In all 11 patients who had surgery the surgical findings of instability correlated with the MRI findings. When combined, the MR criteria were 100% sensitive for instability of OCD lesions of the elbow.Conclusion: The vast majority of OCD of the elbow occurs in the capitellum. When used together, the MR criteria for instability were 100% sensitive for evaluation OCD lesions of the elbow.

Apparent diffusion coefficient values of mediastinal masses in children

Ahmed Abdel Khalek Abdel Razek, Nermin Soliman, Rasha Elashery — 2012-06-01

Abstract: Objective: Compare apparent diffusion coefficient (ADC) values between benign and malignant mass lesions in a cohort of children referred for imaging of a mediastinal mass.Material and methods: Prospective study including 24 consecutive children (11 boys, 13 girls aged 5months to 16years). All underwent echo planar diffusion weighted MR imaging of the mediastinum with b-factors of 0 and 600s/mm2. Apparent diffusion coefficient (ADC) values were calculated and correlated with the surgical finding or biopsy.Results: The mean ADC value of malignant mediastinal tumors was 0.91 (S.D., 0.17) ×10−3mm2/s and of benign lesions 1.8 (S.D., 0.33) ×10−3mm2/s. There was significant different in the ADC value between malignant tumors and benign mediastinal tumors (P<0.001). Selection of 1.2×10−3mm2/s as a threshold value for differentiating malignant from benign mediastinal masses has an accuracy of 93%, sensitivity of 92%, specificity of 94%, positive predictive value of 94%, negative predictive value of 92% and area under the curve of 0.962.Conclusion: Apparent diffusion coefficient value is a promising non-invasive parameter for assessment of mediastinal mass in children.

HRCT-features of Pneumocystis jiroveci pneumonia and their evolution before and after treatment in non-HIV immunocompromised patients

2012-06-01

Abstract: Objective: This study retrospectively analyzes the characteristics and kinetics of pulmonary changes in Pneumocystis jiroveci pneumonia (PJP) before and after treatment as depicted by thin-section-CT in HIV-negative patients.Materials and methods: Serial CT scans of 84 consecutive HIV-negative PJP patients were reviewed retrospectively encompassing a median follow-up of 76 (range, 37–506) days. Along with underlying disease and time span between the onset of symptoms and specific antimicrobial therapy, early and late pulmonary CT-findings were evaluated.Results: Imaging findings at initial diagnosis differed from those in the posttherapeutic setting. In the acute (initial) PJP-phase, most frequent finding was symmetric, apically distributed ground glass opacities (GGO) with peripheral sparing 43% (n=36). These initial changes resolved up to 1st follow-up-examination in 57% (n=48), and finally in all except for two patients after a median period of 13 (mean 26, range 1–58) days following application of specific therapy. In 42% (n=35) architectural distortions occurred, but they resolved after a median period of 27 (mean 60, range 11–302) days. Only in 9 patients, complete resolution could not be documented. Significant correlations of the underlying disease or the time span between the onset of symptoms and specific antibiotic therapy and morphologic kinetic could not be found.Conclusion: Thin-section CT-findings of PJP usually resolve soon after onset of specific therapy. Postinfectious fibrosis rarely occurs following PJP in HIV-negative patients.

Morphologic and functional scoring of cystic fibrosis lung disease using MRI

2012-06-01

Abstract: Magnetic resonance imaging (MRI) gains increasing importance in the assessment of cystic fibrosis (CF) lung disease. The aim of this study was to develop a morpho-functional MR-scoring-system and to evaluate its intra- and inter-observer reproducibility and clinical practicability to monitor CF lung disease over a broad severity range from infancy to adulthood.35 CF patients with broad age range (mean 15.3years; range 0.5–42) were examined by morphological and functional MRI. Lobe based analysis was performed for parameters bronchiectasis/bronchial-wall-thickening, mucus plugging, abscesses/sacculations, consolidations, special findings and perfusion defects. The maximum global score was 72. Two experienced radiologists scored the images at two time points (interval 10weeks). Upper and lower limits of agreement, concordance correlation coefficients (CCC), total deviation index and coverage probability were calculated for global, morphology, function, component and lobar scores.Global scores ranged from 6 to 47. Intra- and inter-reader agreement for global scores were good (CCC: 0.98 (R1), 0.94 (R2), 0.97 (R1/R2)) and were comparable between high and low scores.Our results indicate that the proposed morpho-functional MR-scoring-system is reproducible and applicable for semi-quantitative evaluation of a large spectrum of CF lung disease severity. This scoring-system can be applied for the routine assessment of CF lung disease and maybe as endpoint for clinical trials.

Reduced-dose chest CT with 3D automatic exposure control vs. standard chest CT: Quantitative assessment of emphysematous changes in smokers’ lung parenchyma

2012-06-01

Abstract: Objectives: To determine the capability of reduced-dose chest CT with three-dimensional (3D) automatic exposure control (AEC) on quantitative assessment of emphysematous change in smoker’ lung parenchyma, compared to standard chest CT.Methods: Twenty consecutive smoker patients (mean age 62.8years) underwent CT examinations using a standard protocol (150mAs) and a protocol with 3D-AEC. In this study, the targeted standard deviations number was set to 160. For quantitative assessment of emphysematous change in lung parenchyma in each subject using the standard protocol, a percentage of voxels less than −950 HU in the lung (%LAA−950) was calculated. The 3D-AEC protocol's %LAA was computed from of voxel percentages under selected threshold CT value. The differences of radiation doses between these two protocols were evaluated, and %LAAs−950 was compared with the 3D-AEC protocol %LAAs.Results: Mean dose length products were 780.2±145.5mGycm (standard protocol), and 192.0±95.9 (3D-AEC protocol). There was significant difference between them (paired Student's t test, p<0.00001). Meanwhile, only setting −960 HU yielded no significant difference (paired Student's t test, p=0.32) between %LAAs−950 and 3D-AEC protocol %LAAs. In adopting the feasible threshold CT values of the 3D-AEC protocol, the 3D-AEC protocol %LAAs were significantly correlated with %LAAs−950 (r=0.98, p<0.001) and limits of agreement from Bland–Altman analysis was 0.52±4.3%.Conclusions: Changing threshold CT values demonstrated that reduced-dose chest CT with 3D-AEC can substitute for the standard protocol in assessments of emphysematous change in smoker’ lung parenchyma.

Thin-section chest CT findings in systemic lupus erythematosus with antiphospholipid syndrome: A comparison with systemic lupus erythematosus without antiphospholipid syndrome

2012-06-01

Abstract: Purpose: To assess thin-section chest CT findings in systemic lupus erythematosus (SLE) with antiphospholipid syndrome (APS), in comparison with SLE without APS.Materials and methods: We retrospectively reviewed the medical records and thin-section CT findings of 17 consecutive patients with an established diagnosis of SLE with APS, comparing with 37 consecutive SLE patients without APS, between 2004 and 2008, and patients who had other autoimmune disease, such as Sjögren syndrome, were excluded. No significant differences were seen between the two groups in age, gender, smoking habits, or history of steroid pulse and biological therapy. CT images of 2mm thickness obtained with a 16- or 64-detector row CT were retrospectively evaluated by two radiologists in consensus on ultra high-resolution gray-scale monitors.Results: The frequency of thin-section CT abnormalities was higher in SLE with APS group (82%) than in SLE without APS group (43%). Ground-glass opacity (59%), architectural distortion (47%), reticulation (41%), enlarged peripheral pulmonary artery (29%), and mosaic attenuation (29%) were significantly more common in the SLE with APS group than in the SLE without APS group (Fisher's exact test, p<0.01).Conclusion: SLE patients with APS have increased prevalence of thin-section chest CT abnormalities than those without APS.

Differentiation between Birt–Hogg–Dubé syndrome and lymphangioleiomyomatosis: Quantitative analysis of pulmonary cysts on computed tomography of the chest in 66 females

2012-06-01

Abstract: Backgrounds: Since Birt–Hogg–Dubé syndrome (BHDS) and lymphangioleiomyomatosis (LAM) share some clinical manifestations (multiple pulmonary cysts with pneumothorax, renal tumors, and sometimes skin lesions), the differential diagnosis of the two diseases becomes problem especially in female patients. This study aims to quantify pulmonary cysts in computed tomography (CT) of females with BHDS and those with LAM and also to identify the independent parameters for differentiating the two diseases.Methods: Fourteen patients with BHDS and 52 with LAM were studied. In CT scans, lung fields were defined as areas with fewer than −200 Hounsfield units (HU) and pulmonary cysts as areas consisting of 10 or more consecutive pixels with fewer than −960 HU. The extent, number, size and circularity of cysts were calculated by using hand-made software and compared between the two diseases. Moreover, the lung fields were divided into six zones and analyzed for the distribution of cysts. Finally, a stepwise discriminant analysis employing quantitative measurements of cysts and clinical features was performed.Results: The two diseases were significantly different in all quantitative measurements of cysts. Stepwise discriminant analysis accepted the following four variables: the family history of pneumothorax within the second degree relatives, lower-medial zone predominance of cysts, diffusing capacity and mean size of cysts in this order.Conclusion: The quantitative characteristics of pulmonary cysts are significantly different between BHDS and LAM. The independent parameters for differentiating the two diseases are the family history of pneumothorax, zonal predominance of cysts, diffusing capacity and size of cysts.

Clinical data and CT findings of pulmonary infection caused by different pathogens after kidney transplantation

2012-06-01

Abstract: Purpose: The overall objective was to review clinical data and CT findings of pulmonary infection caused by different pathogens after kidney transplantation in an attempt to help early clinical qualitative diagnosis.Materials and methods: 446 cases of clinically confirmed pulmonary infection after kidney transplantation in recent 10 years were evaluated with respect to the time of occurrence and 89 cases with complete CT data and pathogenic diagnosis were further analyzed for pathogen types and CT manifestations. Statistical analysis was performed using Fisher's exact test.Results: Pulmonary infection reached the peak in 3 months after transplantation. Bacterial infection and mixed infection were predominant between 1 and 6 months. And most tuberculosis occurred after one year. Bacterial (38.2%) and mixed infections (38.2%) were the common types. The next was fungal infection, tuberculosis and viral infection (10.1%, 7.9% and 5.6%, respectively). CT manifestations of pulmonary infections after kidney transplantation were diverse and complex, lacking characteristic signs.Conclusion: More than 3/4 of pulmonary infections after kidney transplantation can be attributed to bacteria and mixed pathogens. The combination of time course, clinical data and CT manifestations plays an important role in the early clinical qualitative diagnosis.

Confident non-invasive diagnosis of pseudolesions of the liver using diffusion-weighted imaging at 3T MRI

2012-06-01

Abstract: Purpose: Pseudolesions of the liver including focal steatosis or non-steatosis and THID (transient hepatic intensity differences) are often challenging, especially when imaging patients with underlying malignant disease. We evaluated the efficacy of diffusion-weighted imaging (DWI) in the diagnostic work-up of pseudolesions.Materials and methods: Forty-eight patients with pseudolesions of the liver were consecutively examined and the images were retrospectively analyzed. MRI was performed on a clinical 3T scanner using T1-GRE in-phase and opposed phase images, T2-TSE-FS, diffusion-weighted sequences (b-value 50, 300, 600), ADC mapping, and dynamic post-contrast T1-VIBE-FS sequences (32 patients received Gd-EB-DTPA and 16 patients received gadolinium chelates). All images were analyzed by two experienced radiologists in consensus. As a standard of reference, we used the T1-w GRE, in-phase and out of phase, and the contrast enhanced series, as well as long-term follow-up.Results: In the 48 patients, a total of 116 liver lesions were found. Of these, 40 were benign and eleven were malignant focal lesions. Benign lesions included one FNH, 26 simple cysts, and twelve hemangiomas. In addition, 65 pseudolesions (20 focal steatosis, 13 focal non-steatosis, and 32 THIDs) were found. All pseudolesions could be identified either on the T1-GRE in-phase and opposed phase images or on the contrast-enhanced series, or on both. However, none of them were visible on the diffusion-weighted images.Conclusion: Pseudolesions are invisible on DWI (negative predictive value=1); therefore, DWI can be used as an additional sequence to significantly increase diagnostic confidence in the differentiation between pseudolesions and other focal liver lesions.

Contrast-enhanced ultrasonic parametric perfusion imaging in the evaluation of antiangiogenic tumor treatment

2012-06-01

Abstract: Purpose: To assess the validity of contrast-enhanced ultrasonic parametric perfusion imaging in the evaluation of antiangiogenic tumor treatment by using histology as the reference standard.Materials and methods: H22 hepatoma-bearing mice were treated with thalidomide or placebo by intraperitoneal injection. Contrast-enhanced ultrasound was performed on day 8 after bolus injection of SonoVue. Three different parametric perfusion images were calculated based on the following parameters: area under the curve (AUC), maximum intensity (IMAX) and perfusion index (PI). A score from 1 to 5 (1=low, 5=excellent) was used for analysis of parametric perfusion images by two independent readers. Immunohistochemical analysis was performed for evaluation of microvascular density (MVD).Results: Treatment with thalidomide resulted in a significant decrease in perfusion scores assigned to AUC, IMAX and PI parametric images as compared with control tumors (P<0.001). Immunohistochemistry showed significant decreases of MVD in treated tumors as compared with control tumors (P=0.002). MVD was positively correlated with the perfusion scores assigned to AUC parametric images (r=0.568, P=0.009), IMAX parametric images (r=0.614, P=0.004) and PI parametric images (r=0.636, P=0.003).Conclusion: Contrast-enhanced ultrasonic parametric perfusion imaging provides a noninvasive tool to directly visualize tumor perfusion changes after antiangiogenic tumor treatment.

The influence of body temperature on image contrast in post mortem MRI

2012-06-01

Abstract: Objective: To assess the temperature dependency of tissue contrast on post mortem magnetic resonance (PMMR) images both objectively and subjectively; and to visually demonstrate the changes of image contrast at various temperatures.Materials and methods: The study was approved by the responsible justice department and the ethics committee. The contrast of water, fat, and muscle was measured using regions of interest (ROI) in the orbit of 41 human corpses to assess how body temperature (range 2.1–39.8°C) relates to image contrast of T1-weighted (T1W) and T2-weighted (T2W) sequences on PMMR. Regressions were calculated using the method of least squares. Three readers judged visible changes of image contrast subjectively by consensus.Results: There was a positive relationship between temperature and contrast on T1-weighted (T1W) images and between temperature and the contrast of fat/muscle on T2-weighted (T2W) images. There was a negative relationship between temperature and the contrast of water/fat and water/muscle on T2W images. Subjectively, the influence of temperature became visible below 20°C on T2W images, and below 10°C on T1W images.Conclusion: Image contrast on PMMR depends on the temperature of a corpse. Radiologists involved in post mortem imaging must be aware of temperature-related changes in MR image contrast. To preserve technical quality, scanning corpses below 10°C should be avoided.

Comparison of clinical and MR imaging outcomes after uterine fibroid embolization with Bead Block and Embosphere

2012-06-01

Abstract: Purpose: To compare clinical and imaging outcomes after uterine fibroid embolization (UFE) with Embosphere versus Bead Block microspheres.Materials and methods: Our institutional review board approved this HIPAA-compliant study. We conducted a retrospective review of all consecutive UFEs performed for symptomatic uterine fibroids at our academic institution from 2001 to 2008. UFE was performed using Embosphere (n=70) or Bead Block (n=55) microspheres. Patient symptoms and MR images were reviewed before and following UFE. The MR images were analyzed for changes in the size and contrast enhancement of the dominant fibroid and the uterus.Results: 125 patients underwent UFE. Pre-treatment characteristics (patient age, presenting symptoms, fibroid location, and volume of the largest fibroid) were similar across groups. Procedure endpoint (near-stasis, reached in 94% of cases), duration, and sedation medication doses were also similar. Clinical follow-up was available in 69 (55%) patients (mean duration: 13.6 months). Of these, 92% had clinical improvement of their main presenting symptom(s) and 3% developed early menopause. MRI follow-up was available in 105 (84%) patients (mean 7.8 months). Mean volume reduction of the largest fibroid was similar after Embosphere (48%) and Bead Block (53%, p=NS). Residual enhancement ≥5% in the dominant fibroid was similarly uncommon after Bead Block (19%) or Embosphere (16%, p=NS). Mean uterine volume reduction was similar across groups (38%); no myometrial infarction occurred.Conclusion: This retrospective study showed no superiority of Embosphere over Bead Block microspheres in terms of clinical and imaging outcomes after UFE.

Evaluation of MR diffusion-weighted imaging in differentiating endometriosis infiltrating the bowel from colorectal carcinoma

2012-06-01

Abstract: Objective: Endometriosis infiltrating the bowel may be difficult to differentiate from colorectal carcinoma in cases that present with non-specific clinical and imaging features. The aim of this study is to assess the value of MR diffusion-weighted imaging (DWI) in differentiating endometriosis infiltrating the bowel from colorectal carcinoma.Methods: In 66 patients, MR DWI was added to the standard imaging protocol in patients visiting our outdoor MR clinic for the analysis of suspected or known deep infiltrating endometriosis (DIE). In patients diagnosed with DIE infiltrating the bowel on MR imaging, high b-value diffusion-weighted images were qualitatively assessed by two readers in consensus and compared to high b-value diffusion weighted images in 15 patients evaluated for colorectal carcinoma. In addition, ADC values of lesions were calculated, using b-values of 50, 400 and 800s/mm2.Results: A total of 15 patients were diagnosed with DIE infiltrating the bowel on MR imaging. Endometriosis infiltrating the bowel showed low signal intensity on high b-value diffusion-weighted images in all patients, whereas colorectal carcinoma showed high signal intensity on high b-value diffusion-weighted images in all patients. Mean ADC value in endometriosis infiltrating the bowel (0.80±0.06×10−3mm2/s) was significantly lower compared to mean ADC value in colorectal carcinoma (0.86±0.06×10−3mm2/s), but with considerable overlap between ADC values.Conclusion: Only qualitative assessment of MR DWI may be valuable to facilitate differentiation between endometriosis infiltrating the bowel and colorectal carcinoma.

Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis

2012-06-01

Abstract: Introduction: Endometriosis represents an important clinical problem in women of reproductive age with high impact on quality of life, work productivity and health care management. The aim of this study is to define the role of 3T magnetom system MRI in the evaluation of endometriosis.Materials and methods: Forty-six women, with transvaginal (TV) ultrasound examination positive for endometriosis, with pelvic pain, or infertile underwent an MR 3.0T examination with the following protocol: T2 weighted FRFSE HR sequences, T2 weighted FRFSE HR CUBE 3D sequences, T1 w FSE sequences, LAVA-flex sequences. Pelvic anatomy, macroscopic endometriosis implants, deep endometriosis implants, fallopian tube involvement, adhesions presence, fluid effusion in Douglas pouch, uterus and kidney pathologies or anomalies associated and sacral nervous routes were considered by two radiologists in consensus. Laparoscopy was considered the gold standard.Results: MRI imaging diagnosed deep endometriosis in 22/46 patients, endometriomas not associated to deep implants in 9/46 patients, 15/46 patients resulted negative for endometriosis, 11 of 22 patients with deep endometriosis reported ovarian endometriosis cyst. We obtained high percentages of sensibility (96.97%), specificity (100.00%), VPP (100.00%), VPN (92.86%).Conclusion: Pelvic MRI performed with 3T system guarantees high spatial and contrast resolution, providing accurate information about endometriosis implants, with a good pre-surgery mapping of the lesions involving both bowels and bladder surface and recto-uterine ligaments.

Co-existence of bilateral fetal type posterior cerebral artery and the bilateral giant internal carotid artery aneurysms in an ataxic patient

Konuralp Ilbay, Ozgur Ismailoglu, Baki S. Albayrak — 2012-06-01

We encountered a very unusual case of bilateral unruptured giant internal carotid artery aneurysms in a patient with hypoplastic vertebrobasilar system. Fifty-five year old man admitted to our outpatient clinic with the complaints of dizziness and imbalance. The neurological exam was unremarkable except mild truncal ataxia. Computed tomography (CT) and CT angiography (CTA) revealed two giant aneurysms; the right-sided one was a saccular internal carotid artery (ICA) aneurysm (45mm×35mm×33mm in size) extending to the posterior communicating artery and the left-sided one was a fusiform supraclinoid ICA aneurysm (26mm×16mm×15mm in size) (A–C). Additionally, both vertebral arteries were seriously hypoplastic and the basilar artery was atrophic in the mid portion with its thin portion distally. It was noted that there is a bilateral (so called fetal) origin of the posterior cerebral artery from the ICA with hypoplasia of the vertebrobasilar system. Upon these findings in CTA, we planned digital subtraction angiography; however patient did not give written consent after being informed about the procedure. Patient was discharged off the hospital even though he was informed regarding the potentially life threatening unruptured aneurysms. The symptomatology of the patient was unlikely related to the direct compressive effects of the aneurysms, instead; insufficient blood supply to cerebellum due to the hypoplastic vertebrobasilar system seemed as the cause of truncal ataxia. In the relevant literature, we did not encounter such concomitant occurrence of bilateral giant aneurysms and bilateral fetal type posterior cerebral artery in a patient complaining of ataxia. In conclusion, even though it is arguable, giant bilateral ICA aneurysms may have negative hemodynamic influence on the vaguely established compensatory perfusion mechanism from anterior to posterior circulation in the setting of hypoplastic vertebrobasilar system.

Re: Wieczorek AP, et al. “3-D high-frequency endovaginal ultrasound of female urethral complex and assessment of inter-observer reliability.” Eur J Radiol 2010 Oct 20 [Epub ahead of print]

Nishee Calandrini, G. Alessandro Digesu, Vik Khullar — 2012-06-01

Wieczorek et al. must be congratulated for their effort in studying the use of a three dimensional (3D) high frequency (12MHz) endovaginal ultrasound for assessing the urethral complex in asymptomatic nulliparous women .

Contrast enhanced breast MRI: Spatial displacement from prone to supine patient's position. Preliminary results

2012-04-16

Abstract: Objective: To estimate the spatial displacement of breast lesions and nipples in MR images when the patient is moved from the standard prone to a supine position close to ultrasound (US) or surgical setting.Materials and methods: Eleven patients underwent breast MRI in prone position with dynamic 3D T1-weighted sequences using 0.1mmol/kg gadobenate dimeglumine. Subsequently, the patient was repositioned in supine position and a 3D volumetric interpolated breathhold examination sequence was acquired using a thoracic surface coil. For both positions we measured the following minimal distances: (A) from lesion margin to the coronal plane passing through the anterior surface of the sternum, antero-posterior, on native axial images; (B) from lesion margin to the medial sagittal plane, on native axial images, latero-medial; (C) from lesion margin to the axial plane passing through the tracheal bifurcation, cranio-caudal; (D) from lesion margin to the thoracic wall/pectoral muscle, on native axial images; (E) from lesion margin to the skin, on native axial images; (F) from lesion margin to the base of the nipple, on oblique reconstructions. Measurements from A to D were also obtained for each nipple. The prone-to-supine spatial displacement was calculated as the absolute difference between the measurement obtained in supine position and the same measurement obtained in prone position. Displacements were presented as mean±standard deviation and median in parenthesis.Results: Lesion displacements were (mm): A=60±38 (55); B=40±26 (41); C=41±33 (34); D=32±31 (27); E=6±5 (7); and F=8±6 (7). Nipple displacements were (mm): A=84±44 (91); B=54±24 (56); C=27±15 (24); and D=48±20 (48).Conclusion: These preliminary results show that preoperative breast MRI in prone position implies a median lesion displacement of about 3–6cm along the three orthogonal directions in comparison with supine MRI. Conversely, median lesion-to-skin and lesion-to-nipple displacements were less than 1cm, even though nipple displacements were similar to or larger than those of lesions. The lesion-to-nipple distance may be the most reliable measure to be used for second look breast US. Larger studies are warranted in order to define an optimized breast MRI protocol in the preoperative setting.